Dilation and curettage, diagnostic and/or therapeutic (nonobstetrical)
CPT4 code
Name of the Procedure:
Dilation and Curettage (D&C)
Summary
Dilation and Curettage, commonly referred to as D&C, is a procedure where the cervix is dilated (widened) to allow a special instrument to be inserted into the uterus. This instrument is used to scrape or suction away the lining of the uterus for diagnostic or therapeutic purposes.
Purpose
D&C addresses abnormal uterine bleeding, uterine polyps, fibroids, and missed or incomplete miscarriages. The goals of the procedure include diagnosing uterine conditions, stopping abnormal bleeding, and clearing the uterine lining.
Indications
- Heavy or prolonged menstrual periods
- Irregular or excessive menstrual bleeding
- Postmenopausal bleeding
- Uterine polyps or fibroids
- Incomplete miscarriage or retained tissue
Preparation
- Fasting for 6-8 hours before the procedure
- Stopping certain medications as advised by the doctor
- Undergoing pre-procedure blood tests or imaging studies
- Arranging for a ride home post-procedure due to sedation
Procedure Description
- Patient is positioned and given anesthesia (local, regional, or general).
- The cervix is gently dilated using special instruments.
- A curette (a spoon-shaped instrument) or suction device is inserted to remove tissue from the uterine lining.
- The tissue is collected for examination if needed.
Duration
The procedure typically takes 15-30 minutes.
Setting
D&C is usually performed in a hospital, outpatient clinic, or surgical center.
Personnel
- Gynecologist or obstetrician-gynecologist (OB-GYN)
- Anesthesiologist (if general or regional anesthesia is used)
- Nurses and surgical assistants
Risks and Complications
- Common risks: Bleeding, cramping, infection
- Rare risks: Uterine perforation, adhesions (Asherman syndrome)
- Management includes antibiotics for infection and monitoring for complications
Benefits
- Accurate diagnosis of uterine conditions
- Relief from abnormal bleeding or discomfort
- Improvement can be noticed within days to weeks
Recovery
- Rest and avoid strenuous activity for a few days
- Expect light bleeding or spotting for 7-10 days
- Pain management with over-the-counter pain relievers
- Follow-up appointments to monitor recovery
Alternatives
- Medication to manage bleeding or other symptoms
- Hysteroscopy for direct visualization and treatment
- Endometrial ablation for permanent reduction of uterine lining
- Each alternative has its benefits and limitations; D&C is often quicker and effective for immediate issues.
Patient Experience
Patients might feel mild to moderate cramping similar to menstrual cramps post-procedure. Sedation or anesthesia ensures comfort during the procedure. Pain management and comfort measures are provided to ease recovery.